• Hip & pelvis
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• 제35권2호
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• pp.88-98
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• 2023

Purpose: The objectives of this study were to examine the prevalence and risk factors for development of periprosthetic occult femoral fractures during primary cementless total hip arthroplasty (THA) and to assess the clinical consequences of these fractures. Materials and Methods: A total of 199 hips were examined. Periprosthetic occult femoral fractures were defined as fractures not detected intraoperatively and on postoperative radiographs, but only observed on postoperative computed tomography (CT). Clinical, surgical, and radiographic analysis of variables was performed for identification of risk factors for periprosthetic occult femoral fractures. A comparison of stem subsidence, stem alignment, and thigh pain between the occult fracture group and the non-fracture group was also performed. Results: Periprosthetic occult femoral fractures were detected during the operation in 21 (10.6%) of 199 hips. Of eight hips with periprosthetic occult femoral fractures that were detected around the lesser trochanter, concurrent periprosthetic occult femoral fractures located at different levels were detected in six hips (75.0%). Only the female sex showed significant association with an increased risk of periprosthetic occult femoral fractures (odds ratio for males, 0.38; 95% confidence interval, 0.15-1.01; P=0.04). A significant difference in the incidence of thigh pain was observed between the occult fracture group and the non-fracture group (P<0.05). Conclusion: Occurrence of periprosthetic occult femoral fractures is relatively common during primary THA using tapered wedge stems. We recommend CT referral for female patients who report unexplained early postoperative thigh pain or developed periprosthetic intraoperative femoral fractures around the lesser trochanter during primary THA using tapered wedge stems.

• Hip & pelvis
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• 제35권1호
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• pp.47-53
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• 2023

Purpose: The purpose of this study is to compare the radiological results of fixation using the femoral neck system (FNS) and cannulated screw (CS) for treatment of femoral neck fractures. Materials and Methods: A retrospective study of patients with femoral neck fractures who underwent internal fixation and had follow-up of more than six months from 2010 to 2020 was conducted. A total of 87 patients were enrolled in the study. The FNS group included 20 patients and the CS group included 67 patients. Classification of fractures was performed according to Garden and Pauwels classification. Operation time, intraoperative blood loss, sliding distance of the implant, lateral soft tissue irritation caused by implants, and complications were evaluated. Results: The mean operation time was 40.30 minutes in the FNS group and 46.84 minutes in the CS group. The mean intraoperative bleeding volume was 51.25 mL in the FNS group and 72.16 mL in the CS group. Bone union was achieved in 18 patients in the FNS group (90.0%) and in 61 patients in the CS group (91.0%). The mean sliding distance of the implant was 4.06 mm in the FNS group and 3.92 mm in the CS group. No patients in the FNS group and 12 patients in the CS group complained of soft tissue irritation. Conclusion: A shorter operative time, less intraoperative bleeding, and less irritation of soft tissue were observed in the FNS group. FNS could be an alternative to CS for fixation of femoral neck fractures.

• Hip & pelvis
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• 제35권3호
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• pp.193-199
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• 2023

Purpose: Cephalomedullary (CM) nailing is widely performed in treatment of elderly patients with femoral intertrochanteric fractures. However, in cases of fixation failure, re-operation is usually necessary, thus determining factors that may contribute to fixation failure is important. In this study, we examined factors affecting the occurrence of fixation failure, such as age or fracture stability, after CM nailing in elderly patients. Materials and Methods: This study was conducted retrospectively using registered data. From April 2011 to December 2018, CM nailing was performed in 378 cases diagnosed with femoral intertrochanteric fractures, and 201 cases were finally registered. Cases involving patients who were bed-ridden before injury, who died from causes unrelated to surgery, and those with a follow-up period less than six months were excluded. Results: Fixation failure occurred in eight cases. Comparison of the surgical success and fixation failure group showed that the mean age was significantly higher in the fixation failure group compared with the control group (81.3±6.4 vs. 86.4±6.8; P=0.034). A significantly high proportion of unstable fractures was also observed (139/54 vs. 3/5; P=0.040), with a significantly high ratio of intramedullary reduction (176/17 vs. 5/3; P=0.034). A significantly higher ratio of unstable fractures compared with that of stable fractures was observed in the intramedullary reduction group (132/49 vs. 10/10; P=0.033). Conclusion: Fixation failure of CM nailing is likely to occur in patients who are elderly or have unstable fracture patterns. Thus, care should be taken in order to avoid intramedullary reduction.

• 대한정형외과 초음파학회지
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• 제4권1호
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• pp.38-41
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• 2011

대퇴골 전자간 골절에서 근위 대퇴 골수정을 이용한 수술 후 고관절 외측부의 통증을 호소하는 환자들이 있다. 전자부 통증의 원인이 건병증임을 초음파 검사를 통해 확인할 수 있어 그 치험 예를 보고하고자 한다.

• 대한골관절종양학회지
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• 제18권2호
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• pp.99-103
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• 2012

악성 종양 환자에게서 졸레드론산과 같은 비스포스포네이트를 예방적으로 투여받은 경우 이와 관련한 비전형적 대퇴골 골절의 발생 위험성은 아직까지 명확하게 밝혀진 바가 없으며, 국내에 지금까지 보고된 예가 매우 드물다. 본 증례는 다발성 골수종 환자에서 고농도 졸레드론산을 지속적으로 투여받았던 환자에서 큰 외상의 병력 없이 우측 대퇴골 전자하 부위의 비전형적 골절이 발생한 경우로 폐쇄적 정복술 및 골수강 내 금속정 내고정술로 치료한 경험을 보고하고자 한다.

• 대한정형외과학회지
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• 제56권6호
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• pp.535-539
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• 2021

대퇴골 골절 이후 발생하는 혈관계 합병증은 드물지만 발생할 경우 심각한 문제를 초래할 수 있다. 근위 대퇴골 골절에서 직접적인 외상 혹은 근위대퇴골 골수 정 고정술 후 발생한 가성동맥류에 대해서는 몇 차례 증례보고가 있었다. 저자들은 85세 여환에서 원위대퇴골 골절에 대하여 역행성 골수 정 고정술 시행 후, 수술 후 9일째부터 혈색소 감소와, 종창, 통증이 발생했던 것에 대해 수술 후 일시적인 혈종 및 통증으로 오인하였다가, 수술 후 16일째가 되어서야 근위 교합 나사 주변부에서 외측 대퇴 회선 동맥의 하행분지에서 기원한 가성동맥류를 진단하였고, 경피적 혈관 색전술을 시행하여 치료 하였다. 시술 후 혈색소 상승 및 종창, 통증 감소 소견을 보이며 회복하였다.

• 대한족부족관절학회지
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• 제18권2호
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• pp.76-79
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• 2014

In treatment of failure in ankle joint replacement therapy, talar avascular necrosis with massive bone defect, talus fracture with severe comminution and bone defect and ankle dislocation, treatment of large bone defects is considerably important for ankle joint stability and union, therefore, the choice of treatment for large bone defects is use of femoral head or iliac crest bone graft and rigid internal fixation. Because first generation total ankle arthroplasty performed for the first time using a cemented fixation technique requires a large amount of bone resection during re-surgery and there is some possibility of a larger bone defect after removal of implants, in cases where prosthesis for the defect is needed, performance of palliative femoral head or iliac crest bone graft and rigid internal fixation can be difficult. We report on a case of a 48-year-old woman who had experienced ankle pain for 25 years since undergoing total ankle arthroplasty. Because the patient had little ankle motion and rigid soft tissue despite a large bone defect caused by aseptic loosening, a good outcome was obtained only for the femoral cancellous bone graft using allo femoral head without internal fixation.

• Hip & pelvis
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• 제35권4호
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• pp.217-227
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• 2023

Purpose: Periprosthetic femoral fracture (PFF) is a common complication after total hip arthroplasty, and open reduction and internal fixation (ORIF) is a common surgical treatment. We conducted a meta-analysis to compare the outcomes of ORIF in patients with different fracture patterns (Vancouver B1 and B2). Materials and Methods: We conducted a systematic search of PubMed, Embase, Cochrane Library and KoreaMed from inception to August 2022. We conducted a pair-wise meta-analysis (with a fixed-effects model) on the 10 comparative studies and a proportional meta-analysis on the data from the 39 articles to determine a consensus. The outcomes were the incidence of reoperations that included osteosynthesis, irrigation/debridement and revision arthroplasty. Results: The pair-wise meta-analysis showed similar outcomes between two groups; the risk of reoperation (odds ratio [OR]=0.82, confidence interval [CI] 0.43-1.55, P=0.542), nonunion (OR=0.49; CI 0.22-1.10, P=0.085) and deep infection (OR=1.89, CI 0.48-7.46, P=0.361). In proportion meta-analysis, pooled prevalence of reoperation was 9% (95% CI, 6-12) in B1 and 8% (95% CI, 2-15) in B2 (heterogeneity between two groups (Q), P=0.772). The pooled prevalence of nonunion was same as of 4% in B1 and B2 (Q, P=0.678), and deep infection was 2% (95% CI, 1-3) in B1 and 4% (95% CI, 2-7) in B2 (Q, P=0.130). Conclusion: ORIF is a feasible treatment for B1 and B2 periprosthetic femoral fractures, with acceptable outcomes in terms of, nonunion and infection. The results of this study would help clinicians and provide baseline data for further studies validating PFF.

• 한국임상수의학회지
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• 제25권3호
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• pp.215-217
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• 2008

Medical records from the Veterinary Medical Teaching Hospital of the University of Missouri-Columbia from 2004 to 2007 were available for 28 raptors that underwent long bone fracture repair. There were 14 owls, 10 hawks, 2 vultures, 1 eagle, and 1 falcon. Mean body weight was 780 g (ranged from 150 to 1400 g) for 14 owls; 650 g (ranged from 150 to 1270 g) for 10 hawks; 1760 g (ranged from 1520 to 2000 g) for 2 vultures; 5000 g for 1 eagle; and 130 g for 1 falcon. Of all 28 fracture cases, 11 cases (39%) and 1 case (3%) were related to hit-by-car and shooting respectively. Physical examination revealed dehydration in 18 raptors (64%) and lethargy in 12 raptors (42%). Forty one long bone fractures were included in 28 cases. The radiographs revealed 13 ulnar fractures (32%), 12 humeral fractures (30%), 10 radial fractures (25%), 4 tibiotarsal fractures (9%), 1 femoral fracture (2%), and 1 fibular fracture (2%). External skeletal fixation using polymethylmethacrylate (PMMA) combined with intramedullary fixation was used in 19 long bone fractures (46%). Intramedullary fixation using intramedullary Kirschner pin was used in 16 long bone fractures (39%). No surgical treatment was performed in 6 long bone fractures (15%). This study reported that many of raptors presented dehydration and lethargy when admitted for treatment. Therefore, proper hydration and nutrition are critical pre-surgical requirements. In addition, combination of internal fixation and external skeletal fixation using PMMA might be better option to treat raptors with comminuted fracture that results from mostly trauma of hit-by-car.

• Journal of Yeungnam Medical Science
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• 제5권1호
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• pp.17-22
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• 1988

1984년 6월 부터 1987년 8월까지 영남대학교 의과대학 부속병원 정형외과에서 체험한 9예의 대퇴골 결부골절에 대한 분석결과는 아래와 같다. 골절의 원인은 교통사고가 대부분(5예)이었으며, 성별로는 여자 6예, 남자 3예였다. 골절의 유형은 제 2형(transcervical)이 6예로 가장 많았다. 치료는 4예에서 도수정복후 내고정하였으며 3예에서는 관혈적정복 및 내고정했고, 2예에서 견인과 석고붕대 고정하였다. 치료결과는 6예에서 우수하였으나, 3예에서 불량하였다. 불량한 예는 모두 고관절, 대퇴경부 및 대퇴골두에 합병증이 생긴 경우였다. 교통사고 등 사고예방에 관심을 높여야 하고, 빠른 진단과 적절한 내고정방법들이 중요한 것으로 생각되었다.